肾癌螺旋CT灌注成像与微血管生成的相关性研究

Correlation between spiral CT perfusion imaging and tumor angiogenesis in renal cell carcinoma

目的探讨肾细胞癌螺旋CT灌注扫描参数与肿瘤微血管密度及血管内皮生长因子的相关性。方法选择39例肾细胞癌初诊病例,经平扫后选择靶平面行灌注扫描,得到灌注参数。病变及正常肾皮质组织切片经Ⅷ因子相关抗原,血管内皮生长因子免疫组化染色。将所获灌注参数与相应组织病理学改变进行比较研究。结果①各级别肾细胞癌间及肾细胞癌与正常肾皮质相对血容量、血流量、增强峰值差异均有显著性意义。各级别肾细胞癌间及肾细胞癌与正常肾皮质达峰时间差异无显著性意义。②各级别肾细胞癌间及肾细胞癌与正常肾皮质微血管密度差异均有显著性意义;各级别肾细胞癌间血管内皮生长因子差异无显著性意义。③CT灌注参数中,相对血容量、血流量、增强峰值与癌组织微血管密度有明显相关关系;达峰时间与微血管密度间无显著相关性。血管内皮生长因子与各灌注参数无显著相关性。结论根据肾细胞癌螺旋CT灌注扫描参数,可推测肿瘤血管是否丰富以及肿瘤组织结构特点,为术前诊断及治疗提供依据。

Objective To investigate the correlation of CT perfusion parameters with tumor microvessel density （MVD） and vascular endothelial growth factor （VEGF）. Methods The study included 39 cases of RCC proven histopathologically. Target-slice perfusion scanning was performed for all patients. The time-density curves were generated with measurement of relevant parameters including： relative blood volume （rBV）, blood flow （BF）, peak enhancement （PE）, time to peak （TTP）. Histopathological slides were carefully prepared for the standard F8RA immunohistochemical staining and tumor MVD, VEGF. Results ①There were significant differences for BF, BV and PE between different tumor cell grades, renal cell carcinoma and normal renal cortex. There was no significant association for TTP between different tumor cell grades, renal cell carcinoma and normal renal cortex. ② There were significant differences for MVD between different tumor cell grades, renal cell carcinoma and normal renal cortex. There was no significant association for VEGF between different tumor cell grades.③CT perfusion parameters, including BF, rBV, PE, had significant correlations with MVD of lesions. TTP had no correlation with MVD of lesions. There was no correlation between perfusion parameters and VEGF. Conclusion The CT perfusion parameters were related with tumor MVD, and could reflect the distribution characteristics of tumor microvessels within RCC lesions. CT perfusion scanning was a valuable means to assess the angiogenic activity and tumor vascularity in vivo for RCC patients, and was significant in the diagnosis and treatment of renal cell carcinoma.